I wanted to thank all of those that follow this blog for your continued support and guidance. Some of you are aware of the fact that I have been changing positions over the last several months. I appreciate very much the patience that you’ve extended to me during this time period. The terms of my leaving my former position required that I remain discrete. As a result, I was not allowed to notify you of my planned departure or assist you in your transition. I apologize to you for that. It was not my choice nor was it how I would have preferred to depart. I want to now welcome you to contact me so that I can provide you with the support and guidance that you so deserve on your pathway to parenthood. Let me please explain further so that everyone understands why I am so very excited to now be a member of the Conceptions Reproductive Associates team!
Our specialty is very success driven. My efforts have always been to bring the latest and greatest techniques to patients in each and every community that I’ve lived in. When I’ve been unable to do so, I’ve chosen to move to where I was able to confidently offer women the most comprehensive range to treatment options available. With my current relocation to Denver, CO I’m pleased to say that I’m done moving. Although not every patient needs the most high tech assistance, I’m finally at a location that is able to do it all. The result is a center with one of the highest pregnancy rates documented as well as one of the lowest miscarriage rate. That is what the technology has to offer. However, on the flipside we are also able to offer basic supportive care as well as everything else in between. Bottom line is that I couldn’t feel any better about the group that I am now working with.
For those of you that have been readers of this blog and have not been patients of mine, please forgive this post if it seems self promotional. I decided to write this post in response to the many emails that I have received wondering where I was and how they could reach me. To anyone interested, I would welcome the opportunity to meet with you in person, over the phone or on the internet for a consultation. Rest assured that if you choose to come to Denver we will offer you the same hospitality and success that the patients in this area have enjoyed for so long now. You might even like it so much that you too might choose to stay!
In gratitude to all,
Robert Greene, MD, FACOG
Conceptions Reproductive Associates of Colorado
It’s time to review the latest findings in Reproductive Medicine. This month there are new insights into why more boys are born in the US than girls as well as a new strategy for women undergoing fertility treatment to reduce the risk of having a child with autism. As always, I have included links to the studies for you check them out for yourself:
- More Boys are Born than Girls; here’s why—about 51% of all of the babies born are male. This observation has been consistent for several hundred years. A new study has provided the most comprehensive data to explain why we don’t see an equal number of boys and girls in the delivery room. It turns out that the explanation is based upon what happens during pregnancy; not prior to fertilization as previously assumed. The researchers found that although a higher number of male are lost during the first trimester; female fetuses are more likely to miscarry later in pregnancy. The end result is that a slightly higher number of males survive until birth than females.
- Supplementing Estrogen Does Not Improve Pregnancy Outcome—there has long been debate amongst fertility centers as to whether or not additional estrogen is beneficial to pregnancy rates. New data shows that levels higher than the normal physiologic ones are not helpful. Other studies have suggested the extra estrogen may even boost the risk of blood pressure problems later in pregnancy. Combined these findings support the ongoing trend to create a hormonally balanced environment rather than simply adding more.
- Genetic Testing improves Live Birth Rate in Women over 40—using pre-implantation genetic screening (PGS) to identify the healthiest embryos for transfer is an effective tool according to new information . They demonstrated a live birth rate that was three times higher using this technique then using standard IVF alone for women over 40. This means that identifying healthy embryos prior to transfer is a highly effective strategy to achieve a successful birth.
- Single Embryo Transfer associated with Lower Risk of Autism—previous data has suggested that there may be a higher risk of Autism Spectrum Disorder (ASD) associated with advanced reproductive techniques (ART). Other studies have shown that this is more likely age related or that it might be due to the population of patients seeking fertility treatment. This new study found that when only singleton pregnancies result following IVF; the observed risk disappears. This is another good reason to consider elective single embryo transfer (ESET).
- Vitamin D Deficiency associated with Lower Pregnancy Rate in IVF—a comprehensive review of 34 published trials has found that women with lower than normal vitamin D levels have less success when undergoing IVF treatment. There is not yet proof that supplementing with vitamin D reverses this trend. However, given the other health benefits and the low cost of this “sunshine hormone” it sure makes sense to consider vitamin D supplementation for women whose level is lower than normal.
- Smoking during Pregnancy can have Lasting Effects Upon your Child—it has long been recognized that women that were smokers had lower fertility rates, higher miscarriage rates and earlier onset of menopause than nonsmokers. New information now suggests that at least some of these negative reproductive effects can be passed on their children as well. Specifically, they found girls born to women that smoked had an earlier onset of puberty than those born to nonsmokers. Noted by the investigators was that early onset of puberty is also linked to a higher risk of certain types of cancer including breast cancer.
[r1]Link to http://www.pnas.org/content/early/2015/03/27/1416546112
[r2]Link to http://link.springer.com/article/10.1007/s10815-014-0402-1?wt_mc=alerts.TOCjournals
[r3]Link to http://link.springer.com/article/10.1007/s10815-014-0417-7?wt_mc=alerts.TOCjournals
[r4]Link to http://consumer.healthday.com/cognitive-health-information-26/autism-news-51/ivf-kids-have-higher-odds-of-autism-study-finds-697622.html
[r5]Link to http://link.springer.com/article/10.1007/s10815-014-0407-9?wt_mc=alerts.TOCjournals
[r6]Link to http://www.reuters.com/article/2015/03/19/us-womens-health-smoking-pregnancy-idUSKBN0MF29W20150319
August 16, 2010 Blog Post
Selecting the best embryo for transfer; what you need to know
One of the greatest challenges involved in infertility treatment is how to improve the pregnancy rate while also keeping the risk of multiple pregnancy (twins, triplets, etc) as low as possible. One strategy for achieving this goal is to let the embryos complete the development in the laboratory—the critical stage of becoming a “blastocyst”—that would normally take place in the fallopian tube. There are many so many studies that support this approach that it has been widely adopted by those centers that can confidently create the environment in the lab for healthy development to occur. Yet this technique still has limitations. One study [G1] recently demonstrated that nearly half of the best looking blastocysts are still genetically abnormal, even for women less than 40 years of age. Embryos selected for transfer before they reach the blastocyst stage only have about a 40% chance of being genetically normal. These studies have driven an interest in making preimplantation genetic screening (PGS) available to more couples going through fertility treatment. To do so can maximize embryo selection as well as provide useful diagnostic information to couples undergoing IVF.
The goal of any fertility program should be one embryo per transfer. But since it is so difficult to predict which embryo is most likely to implant and become a healthy baby, a common strategy is to transfer more in the hope of boosting success. This is often done with the knowledge that if a chromosomally abnormal embryo implants, it has a 99% of miscarrying; compared to a 7% risk of miscarriage for a normal embryo. So PGS can not only boost the pregnancy rate per embryo transferred, it can also reduce the risk of miscarriage as well. Previous studies [G2] questioning the benefits of PGS have been thoroughly analyzed and found that the techniques and the technicians had a big impact upon limiting the successful application of this new tool in those headline-grabbing stories. Emerging research suggests that using PGS to select embryos may result in a pregnancy per transfer rates of 80% or higher; even in high risk patients. The key is to only transfer the embryos that are genetically competent.
Now that the techniques for embryo biopsy and genetic testing have been refined and made more accessible, the challenge is selecting which couples are most likely to benefit from this technology. The goal is to minimize the cost of treatment while also optimizing the outcome. A recently published but exhaustive review [G3] this subject summarized the key selection criteria needed to achieve that goal. Here’s what you should consider as you decide whether or not you’re interested in PGS:
- Couples where the egg comes from a woman that is at least 37 years of age; the time when genetic abnormalities naturally increase in frequency
- There are at least 5 healthy embryos (Grade 1 or 2 with at least 6 cells present) available for testing
- There are at least 8 chromosomes tested including 13,15,16,18, 21, 22, X and Y (the ones most likely to be abnormal)
- Embryo biopsies are only performed by properly trained personnel (>100 biopsies within the last few years with an average of 5 minutes or less per biopsy) to avoid unnecessary damage to the embryo
- Established techniques are used for biopsy preparation
- All samples are sent to experienced labs with strict quality assurance standards
- IVF center has extensive experience in counseling patients and explaining results